Effect Of Circumferential Pulmonary Vein Isolation For Atrial Fibrillation On The Structure Of Left Atrium, Left Atrial Appendage, Pulmonary Veins

Objective:To assess the remodeling and reverse remodeling of left atrium (LA) left atrial appendage (LAA) and pulmonary veins after circumferential pulmonary vein isolation (CPVI) by using64slice multidetector computed tomography (CT).Method:44patients (male29, female15) who underwent64sliced multidetector computed tomography (CT) before and three months or more after CPVI of AF were included in this study. After ablation,14patients (male10, female4) are recurrent AF in follow up period. After doing64sliced CT, we measured left atrium size [the maximal horizontal diameter (LA1), maximal superoinferior diameter (LA2), maximal anteroposterior diameter (LA3), LA roof distance], size of left atrial appendage [LAA dmax, LAA dmin, LAA CS, LAA length], size of orifice of pulmonary vein [dmax and dmin of orifice of LSPV, LIPV, RSPV, RIPV] before and after CPVI.Result:In recurrence group, except LA roof distance (42.06±8.99mm to 36.33±9.36mm, P=0.013) and minimal diameter of orifice of right inferior pulmonary vein (RIPV dmin)(16.90±5.28mm to14.67±5.21mm, P=0.024) reduce than before CPVI, the rest of size of left atrium, left atrial appendage, pulmonary veins are not significant in statistics (P>0.05). In successful ablation group, left atrial chamber size, LAA dmax, LAA CS (cross sectional area), LSPV dmax, LSPV CS, LIPV dmax, LIPV CS, RSPV dmin, RSPV CS after CPVI are significantly reduced than before CPVI. In detecting pulmonary veins stenosis after CPVI, the maximum and minimum diameter reduction rate between25-50%(mild) are60.22%and59.09%and, between50-70%(moderate) are2.27%and1.14%respectively.Conclusion:Structural remodeling of left atrium, left atrial appendage and pulmonary veins can be reversible after successful circumferential pulmonary veins isolation. The size of left atrium, left atrial appendage and pulmonary veins are similar or slightly increased when atrial fibrillation is recurrence after CPVI. After CPVI, size of left atrium is reduced than before CPVI in both persistent and paroxysmal atrial fibrillation groups, but more significance in persistent atrial fibrillation group. There are mild pulmonary stenosis without symptoms in some patients.